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Blue Selections Rx Member Guide

2013

Please bring this guide with you to your next doctor’s visit.

5-Tier 04HQ4231 10/12 Updated: October 2012 Your Guide to Your Prescription Drug Program

Blue Cross and Blue Shield of Louisiana and our subsidiary, HMO Louisiana, Inc. , along with Express Scripts, an independent company that serves as our pharmacy benefit manager, created this Blue Selections Rx Member Guide to help you understand your drug benefits. Because drug benefits can be complex, understanding your benefits is key to getting the most from your health plan.

Throughout the year, our Blue Cross Pharmacy and Therapeutics Committee  a group of Louisiana doctors and pharmacists  reviews published literature about the safety, efficacy, and cost of prescription medicines. The committee helps us ensure that our plans adequately cover as many drugs as we can.

We recognize that you and your doctor always make the final decision for your healthcare needs. So that you can make informed decisions, we encourage you to share this Guide with your doctor at your next visit or before you fill your next prescription. That way you and your doctor may choose the best drug for you while helping to keep your costs down. Please discuss any questions or concerns about your drug therapy with your doctor or pharmacist.

Please Note: Inclusion of a drug in a drug formulary does not guarantee that a member's physician or other authorized prescriber will prescribe the drug for a particular medical condition or mental illness.

What do you need to know about the drugs you take?

Before you fill a prescription for any drug, you should ask these important questions:  Must your doctor get a prior authorization before your plan will pay for your drug?  Are there limits to the quantity of that will be covered each time you fill a prescription?  Must you buy the drug from a specialty pharmacy?  Must you first try a generic before your plan will cover a brand‐name drug for your condition?  Is a lower cost alternative available?

In this Guide, we list the most commonly prescribed drugs. We compiled the answers to these key questions for those drugs in a table so that you can easily look up most of the drugs you may have to take. Note: This Guide does not list all drugs that your plan covers. Also, the list may change. The list may not apply to all benefit plans. Some benefit plans may have different coverage for specific . The Guide applies only to prescription drugs that participating pharmacies dispense on an outpatient basis. See your member contract or certificate for pharmacy coverage for any exclusions and limitations that apply to you.

If your doctor prescribes a drug that is not in this Guide, or if you have any questions, call Express Scripts at 1‐866‐781‐7533. For more information and updates, go to: www.bcbsla.com/pharmacy or www.express‐scripts.com.

How are prescription drugs classified?

Your plan offers a 5‐tier structure for drugs that are covered: Tier Description of prescription drugs 1 Primarily generic drugs, although some brand‐name drugs may fall into this category

2 Brand‐name drugs 3 Brand‐name or generic drugs that may have a therapeutic alternative as a Tier 1 or Tier 2 drug Covered compounded drugs are included in this tier. 4 Brand‐name drugs for which multi‐source brand or generic drugs are available. 5 Injectable drugs that are intended to be self‐administered. Insulin and injectable antihemophilic drugs may be included in another tier.

You will pay the least out‐of‐pocket when you buy generic drugs  or drugs that are in Tier 1. You will pay the most out‐of‐pocket for multi‐source brand drugs in Tier 4 and injectable drugs in Tier 5. Note that if any brand‐name drug loses patent protection after the printing of this publication and it becomes available as a generic equivalent, you must pay the Tier 4 copayment.

How can you find information about your drugs?

In the index, we list drugs alphabetically along with a page reference for the chapter and section in which the drug appears. Simply look for the drug you take and quickly learn several important things:  If your doctor must get prior authorization before your plan will pay for the drug,  If your plan places limits on the quantity that will be covered each time you fill a prescription,  If you must go to a specialty pharmacy,  If you must first try a generic before your plan will cover a brand‐name drug for your condition, or  If a lower cost alternative is available.

Drug Name Restrictions Tier Recommended Alternatives PA QPD SP ST 1 2 3 4 5 generic 

BRAND NAME   generic PREFERRED BRAND NAME   BRAND MULTI-SOURCE BRAND generic NAME  Injectable drug  BRAND NAME drugs are in ALL Shows you if a lower CAPS. PA = Prior authorization cost alternative is QPD = Quantity per dispensing limits available in another Generic drugs are in lower case SP = Specialty pharmacy program restrictions tier. letters. ST = Step therapy restrictions

What do the restriction categories mean?

PA: Medications requiring prior authorization We must authorize certain drugs before your plan will pay for them. After considering current medical literature, the Pharmacy and Therapeutics Committee sets up the criteria needed for the drugs to be authorized. Then, Express Scripts processes the prior authorization requests. If you need prior authorization, have your doctor contact Express Scripts: Call: 1‐800‐842‐2015 Fax: 1‐877‐837‐5922 For the physician fax form, go to: http://www.bcbsla.com/Providers/PharmacyManagement

ST: Medications requiring participation in the Lead with Generics Step Therapy Program In certain drug classes, you must first try a generic before your plan will cover a brand‐name drug for your condition. For example, if Drug A (a generic) and Drug B (a brand‐name) both treat your medical condition, we may require that your doctor prescribe Drug A first. Then if Drug A does not work for you, we will cover a prescription for Drug B. Based on your history, if you cannot tolerate Drug A or if your doctor requests that you try Drug B first, your doctor must first have authorization before your plan will pay for the medication. If you need a prior authorization, have your doctor contact Express Scripts: Call: 1‐800‐842‐2015 Fax: 1‐877‐837‐5922 For physician fax forms, go to: http://www.bcbsla.com/Providers/PharmacyManagement

QPD: Medications that have Quantity Per Dispensing limitations Covered prescriptions have a day‐supply limitation (typically up to a 30‐day supply at a retail pharmacy and up to a 90‐day supply for mail‐order). Your plan also limits the amount of certain drugs that can be dispensed at one time. We call those restrictions Quantity Per Dispensing (QPD) limitations.

QPD limits are additional to the day‐supply limitation and are based on the manufacturer’s recommended dosage and duration of therapy, common usage for episodic or intermittent treatment, FDA‐approved recommendations or clinical studies, and as determined by BCBSLA. QPD limits or allowances are subject to quantity limits per day supply, per dispensing event, or any combination of the two. See your member contract or certificate for the limits for your plan. For a complete list of drugs and their QPD limitations, go to: www.bcbsla.com/pharmacy.

SP: Specialty Pharmacy Program restrictions Certain drugs are commonly called specialty drugs. Specialty drugs include biotechnology drugs or other drug products that may require special ordering, handling, or customer service. Your policy may require you to buy these drugs at a network specialty pharmacy to receive in‐ network benefits. Your policy may also limit specialty drugs to the retail day supply listed in your plan (typically a 30‐day supply). See your Schedule of Benefits for any restrictions that apply to you. For a complete list of drugs included in the Specialty Pharmacy Program, go to: www.bcbsla.com/pharmacy. For information about our contracted specialty pharmacies, call the Customer Service number on your member ID card.

For a copy of this guide, go to: www.bcbsla.com/pharmacy Or call Express Scripts Customer Service toll‐free at: 1‐866‐781‐7533

04HQ4231 10/12

* Express Scripts, Inc. is an independent company that serves as the pharmacy benefit manager for Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc. .

TABLE OF CONTENTS

Chapter Name Chapter 1 ANESTHETICS Chapter 2 ANTIINFECTIVES Chapter 3 ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS Chapter 4 CARDIOVASCULAR MEDICATIONS Chapter 5 AUTONOMIC & CNS MEDICATIONS Chapter 6 DERMATOLOGICAL MEDICATIONS Chapter 7 EAR-NOSE-THROAT MEDICATIONS Chapter 8 ENDOCRINE MEDICATIONS Chapter 9 GASTROINTESTINAL MEDICATIONS Chapter 10 IMMUNOLOGICALS & VACCINES Chapter 11 MUSCULOSKELETAL MEDICATIONS Chapter 12 NUTRITION, BLOOD Chapter 13 OBSTETRICAL & GYNECOLOGICAL MEDICATIONS Chapter 14 OPHTHALMIC MEDICATIONS Chapter 15 RESPIRATORY MEDICATIONS Chapter 16 UROLOGICAL MEDICATIONS Chapter 17 DIAGNOSTIC & MISCELLANEOUS MEDICATIONS Chapter 18 MEDICAL (MISCELLANEOUS) SUPPLIES

TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES CHAPTER 1: ANESTHETICS 1.2 TOPICAL ANESTHETICS hcl viscous X lidocaine-prilocaine X LIDODERM PA X lidocaine hcl CHAPTER 2: ANTIINFECTIVES 2.1.1 CEPHALOSPORINS cefaclor X cefadroxil X cefdinir X cefpodoxime X cefprozil X cefuroxime X cephalexin X CEDAX X cefaclor, amoxicillin SUPRAX X cefaclor, cefuroxime 2.1.3 CLINDAMYCINS hcl X clindamycin palmitate hcl X 2.1.4 X 2.1.4.1 OTHER MACROLIDES azithromycin X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES clarithromycin, -er X 2.1.4.2 KETOLIDES KETEK, -PAK X 2.1.5 PENICILLINS ampicillin trihydrate X amox tr/potassium clavulanate X amoxicillin X amoxicillin-clavulanate er X penicillin v potassium X AUGMENTIN 125-31.25MG amox tr/potassium (Suspension) X clavulanate amox tr/potassium AUGMENTIN ES/XR X clavulanate MOXATAG X amoxicillin 2.1.6 SULFONAMIDES sulfamethoxazole/trimethoprim X 2.1.7 doxycycline hyclate X doxycycline monohydrate X minocycline hcl X hcl X DORYX DR 150MG ST X doxycycline hyclate ORACEA ST X doxycycline monohydrate SOLODYN ER 45MG, 90MG, 135MG ST X minocycline SOLODYN ER 55MG, 65MG, 80MG, 105MG, 115MG ST X minocycline 2.1.8 URINARY ANTIINFECTIVES nitrofurantoin X nitrofurantoin mono-macro X trimethoprim X 2.1.9 QUINOLONES ciprofloxacin hcl, - er X levofloxacin X ofloxacin X AVELOX/ABC PACK X levofloxacin LEVAQUIN X levofloxacin 2.2 TOPICAL ANTIBACTERIAL DRUGS 2% ointment X silver sulfadiazine X ALTABAX X BACTROBAN CREAM X BACTROBAN NASAL OINTMENT X 2.3 ORAL DRUGS fluconazole QPD X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES itraconazole QPD X X nystatin X terbinafine hcl QPD X voriconazole QPD X 2.4.1 VAGINAL X nystatin X X 2.4.2 OTHER TOPICAL ANTIFUNGALS ciclopirox X clotrimazole X econazole nitrate X ketoconazole X nystatin X NAFTIN X econazole, ketoconazole OXISTAT X econazole, ketoconazole 2.4.3 TOPICAL ANTIFUNGAL- COMB. clotrimazole/ X nystatin w/ X 2.5.1 ANTIRETROVIRALS & PROTEASE INHIBITORS stavudine X zidovudine X ATRIPLA X COMBIVIR X zidovudine-lamivudine COMPLERA X EMTRIVA X EPIVIR SOLUTION X EPIVIR TABLETS X lamivudine FUZEON SP X INCIVEK PA/QPD/SP X INTELENCE X LEXIVA X NORVIR X REYATAZ X TRIZIVIR X TRUVADA X VICTRELIS PA/QPD/SP X INCIVEK VIRAMUNE XR X ZIAGEN SOLUTION X ZIAGEN TABLETS X abacavir 2.5.2 OTHER ANTIVIRAL DRUGS acyclovir X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES famciclovir QPD X ribasphere QPD/SP X ribavirin QPD/SP X rimantadine hcl X valacyclovir QPD X BARACLUDE SP X EPIVIR HBV X amantadine hcl, rimantadine RELENZA QPD X hcl amantadine hcl, rimantadine TAMIFLU QPD X hcl VALTREX QPD X valacyclovir 2.6 TOPICAL ANTIVIRAL DRUGS ZOVIRAX 5% OINTMENT X 2.7.2 ANTITUBERCULOSIS DRUGS

isoniazid X

rifampin X

MYCOBUTIN X 2.7.3 PLASMODICIDES hydroxychloroquine sulfate X 2.7.5 TRICHOMONOCIDES metronidazole X TINDAMAX X tinidazole 2.8 OTHER ANTIINFECTIVE DRUGS bacitracin X MEPRON X NEBUPENT X XIFAXAN X CHAPTER 3: ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS 3.0 ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS anastrozole X azathioprine X cyclosporine (oral) X flutamide X leflunomide QPD X letrozole X mercaptopurine X methotrexate (oral) X mycophenolate (oral) X (oral) X tamoxifen citrate X ARIMIDEX X anastrozole CIMZIA PA/QPD/SP/ST X ENBREL, HUMIRA ENBREL PA/QPD/SP X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES FEMARA X letrozole HUMIRA PA/QPD/SP X KINERET QPD/SP X NEXAVAR SP X PROGRAF X tacrolimus REVLIMID QPD/SP X SIMPONI PA/QPD/SP/ST X ENBREL, HUMIRA SPRYCEL QPD/SP X STELARA PA/QPD/SP X SUTENT QPD/SP X TARCEVA SP X CHAPTER 4: CARDIOVASCULAR MEDICATIONS 4.1 CARDIAC GLYCOSIDES digoxin X LANOXIN X 4.2 CALCIUM ANTAGONISTS besylate X cartia xt X diltiazem 24hr er/24hr cd X diltiazem hcl/ er X er X isradipine X hcl X nifediac cc X nifedical xl X er X X verapamil hcl/er/er pm X DYNACIRC CR X amlodipine, felodipine er NORVASC X amlodipine besylate 4.3.1 LOOP DIURETICS bumetanide X furosemide QPD X torsemide X 4.3.2 THIAZIDE AND RELATED DRUGS chlorthalidone X hydrochlorothiazide QPD X indapamide X metolazone X 4.3.3 POTASSIUM SPARING DIURETICS X spironolactone/hctz X triamterene/hctz QPD X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES 4.4 BETA-ADRENERGIC ANTAGONIST DRUGS acebutolol hcl X atenolol QPD X bisoprolol fumarate X X labetalol hcl X metoprolol succ er X metoprolol tartrate QPD X nadolol X pindolol X propranolol hcl X timolol maleate X atenolol, metorprolo succ er, BYSTOLIC ST X carvedilol COREG CR ST X carvedilol INNOPRAN XL ST X propranolol hcl TOPROL XL ST X metoprolol succ er 4.5.1 VASODILATOR ANTIHYPERTENSIVES doxazosin mesylate QPD X hydralazine hcl X prazosin hcl QPD X terazosin hcl QPD X 4.5.2 CENTRALLY ACTING ANTIHYPERTENSIVES clonidine hcl X clonidine patch QPD X guanfacine hcl X methyldopa X 4.5.4.1 ANGIOTENSIN CONVERTING ENZYME INHIBITORS benazepril hcl QPD X captopril QPD X enalapril maleate QPD X fosinopril sodium QPD X lisinopril QPD X moexipril hcl QPD X perindopril erbumine QPD X quinapril hcl QPD X ramipril QPD X trandolapril QPD X 4.5.4.2 ANGIOTENSIN II RECEPTOR ANTAGONISTS eprosartan mesylate QPD X irbesartan QPD X losartan potassium QPD X generic ACEI, losartan, ATACAND ST/QPD X irbesartan, BENICAR TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES

AVAPRO ST/QPD X irbesartan BENICAR ST/QPD X DIOVAN ST/QPD X generic ACEI, losartan, EDARBI ST/QPD X irbesartan, BENICAR generic ACEI, losartan, MICARDIS ST/QPD X irbesartan, BENICAR

generic ACEI, eprosartan, TEVETEN ST/QPD X losartan, irbesartan, BENICAR 4.5.6 OTHER ANTIHYPERTENSIVES amlodipine besylate-benazepril X atenolol-chlorthalidone X benazepril-hctz X bisoprolol fumarate-hctz X candesartan cilexetil-hctz X captopril-hctz X enalapril maleate-hctz X fosinopril-hctz X irbesartan-hctz X lisinopril-hctz QPD X losartan-hctz X moexipril-hctz X nadolol-bendroflumethiazide X propranolol hcl w/hctz X quinapril-hctz X quinaretic X valsartan-hctz X

ATACAND HCT ST X candesartan cilexetil-hctz

AVALIDE ST X irbesartan-hctz AZOR ST X BENICAR HCT ST/QPD X

DIOVAN HCT ST X valsartan-hctz EXFORGE/HCT ST/QPD X generic ACEI-hctz, losartan- hctz, irbesartan-hctz, MICARDIS HCT ST X BENICAR HCT generic ACEI, losartan, TEKTURNA ST/QPD X irbesartan generic ACEI-hctz, losartan- TEKTURNA HCT ST X hctz, irbesartan-hctz generic ACEI-hctz, losartan- hctz, irbesartan-hctz, TEVETEN HCT ST X BENICAR HCT

TRIBENZOR ST/QPD X VALTURNA ST/QPD X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES 4.6.1 NITRATES isosorbide dinitrate X isosorbide mononitrate er X nitroglycerin X NITROSTAT X nitroglycerin 4.6.2 OTHER VASODILATING DRUGS sildenafil PA/QPD/SP X ADCIRCA PA/QPD/SP X REVATIO PA/QPD/SP X sildenafil TYVASO PA/SP X VENTAVIS PA/SP X 4.6.3 ENDOTHELIN RECPTR ANTAGONIST LETAIRIS PA/QPD/SP X TRACLEER PA/SP X 4.7.1.1 CLASS 1A ANTIARRHYTHMICS quinidine gluconate cr/er X 4.7.1.2 CLASS 1B ANTIARRHYTHMICS mexiletine hcl X 4.7.1.3 CLASS 1C ANTIARRHYTHMICS flecainide X propafenone hcl X RYTHMOL SR X propafenone hcl/sr 4.7.3 AMIODARONES hcl X 4.7.5 OTHER ANTIARRHYTHMICS sotalol X MULTAQ X 4.8.1 HYPOLIPOPROTEINEMICS cholestyramine X colestipol hcl X fenofibrate X gemfibrozil X ANTARA X fenofibrate, TRILIPIX FENOGLIDE X fenofibrate, TRILIPIX LIPOFEN X fenofibrate, TRILIPIX LOVAZA PA X NIASPAN ER X TRICOR X fenofibrate, TRILIPIX TRILIPIX X WELCHOL X ZETIA QPD X 4.8.2 HMG-COA REDUCTASE INHIBITORS atorvastatin calcium QPD X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES fluvastatin QPD X QPD X pravastatin sodium QPD X QPD X ALTOPREV ST/QPD X lovastatin CRESTOR ST/QPD X

LESCOL ST/QPD X fluvastatin atorvastatin, lovastatin, pravastatin, simvastatin, LESCOL XL ST/QPD X CRESTOR LIPITOR ST/QPD X atorvastatin atorvastatin, lovastatin, pravastatin, simvastatin, LIVALO ST/QPD X CRESTOR

4.8.2.1 HMG-COA REDUCTASE INHIBITORS COMB. amlodipine-atorvastatin QPD X CADUET ST/QPD X amlodipine -atorvastatin SIMCOR ST/QPD X simvastatin + NIASPAN ER atorvastatin, simvastatin, VYTORIN ST/QPD X CRESTOR 4.9 OTHER CARDIOVASCULAR DRUGS

RANEXA X CHAPTER 5: AUTONOMIC AND CNS MEDICATIONS 5.1.1 ANALGESICS tramadol hcl/er X tramadol w/acetaminophen X 5.1.1.1 CLASS II NARCOTICS endocet X oral transmucosal PA/QPD X fentanyl patch X

hydromorphone hcl X methadone hcl X morphine sulfate/er X oxycodone w/acetaminophen X oxycodone hcl QPD X roxicet X ABSTRAL PA/QPD X fentanyl oral transmucosal AVINZA ST X morphine sr, oxymorphone

EXALGO ST X morphine er, OPANA ER

FENTORA PA/QPD X fentanyl oral transmucosal

KADIAN ER ST X morphine er, OPANA ER NUCYNTA ST/QPD X ONSOLIS PA/QPD X OPANA X oxymorphone TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES

OPANA ER ST/QPD X

OXYCONTIN ST/QPD X oxycodone hcl, OPANA ER 5.1.1.2 CLASS III NARCOTICS acetaminophen-codeine X buprenorphine hcl X hydrocodone-acetaminophen X hydrocodone bit-ibuprofen X BUTRANS QPD X

LORTAB X hydrocodone-acetaminophen SUBOXONE SL FILM PA X SUBOXONE SL TAB PA X SUBOXONE SL FILM 5.1.2 DRUGS TO PREVENT AND TREAT HEADACHES apap/cafffeine/butalbital X aspirin/caffeine/butalbital X butorphanol tartrate QPD X naratriptan hcl QPD X rizatriptan/odt QPD X sumatriptan injection QPD X sumatriptan QPD X naratriptan, rizatriptan, FROVA ST/QPD X sumatriptan, ZOMIG IMITREX INJECTION ST/QPD X sumatriptan injection IMITREX (NON-INJ) ST/QPD X sumatriptan MAXALT ST/QPD X rizatriptan MAXALT MLT ST/QPD X rizatriptan odt naratriptan, rizatriptan, RELPAX ST/QPD X sumatriptan, ZOMIG generic sumatriptan nasal SUMATRIPTAN NASAL SPRAY ST/QPD X spray naratriptan, rizatriptan, TREXIMET ST/QPD X sumatriptan ZOMIG ST/QPD X ZOMIG NASAL SPRAY ST/QPD X ZOMIG ZMT ST/QPD X 5.2.1 ANXIOLYTICS alprazolam/er/xr/odt X buspirone hcl X chlordiazepoxide hcl X clorazepate dipotassium X diazepam X lorazepam X XANAX/XR X alprazolam/er/xr/odt 5.2.2 SEDATIVE/HYPNOTIC DRUGS estazolam QPD X flurazepam hcl QPD X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES temazepam QPD X triazolam QPD X zaleplon QPD X zolpidem tartrate/er QPD X AMBIEN/CR ST/QPD X zolpidem tartrate/er LUNESTA ST/QPD X zolpidem tartrate/er 5.3 ANTIMANIA DRUGS lithium carbonate X 5.4.1 CARBAMAZEPINES /xr X oxcarbazepine X 5.4.2 ANTICONVULSANT BENZODIAZEPINES

clonazepam X 5.4.3 HYDANTOINS X phenytoin sodium extended X DILANTIN X

PHENYTEK X phenytoin sodium 5.4.4 VALPROIC ACID AND DERIVATIVES divalproex sodium/er X valproic acid X DEPAKOTE all forms X divalproex sodium/er 5.4.5 SUCCINIMIDES ethosuximide X CELONTIN X 5.4.6 ANTICONVULSANT BARBITURATES X primidone X 5.4.7 OTHER ANTICONVULSANTS gabapentin X lamotrigine X levetiracetam X topiramate X zonisamide X KEPPRA/XR X levetiracetam LAMICTAL ODT/XR X lamotrigine LYRICA X TOPAMAX X topiramate VIMPAT X 5.5.1.1 TERTIARY AMINES amitriptyline hcl X clomipramine hcl X doxepin hcl X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES imipramine hcl X imipramine pamoate X 5.5.1.2 SECONDARY AMINES nortriptyline hcl X 5.5.1.3 SELECTIVE SEROTONIN REUPTAKE INHIBITORS

citalopram hbr QPD X escitalopram oxalate QPD X

fluoxetine hcl QPD X

fluvoxamine maleate QPD X

paroxetine hcl QPD X

sertraline hcl QPD X

LEXAPRO ST/QPD X escitalopram

LUVOX CR ST/QPD X fluvoxamine citalopram, fluoxetine, VIIBRYD ST/QPD X paroxetine, sertraline ZOLOFT ST/QPD X sertraline hcl 5.5.1.4 OTHER ANTIDEPRESSANTS budeprion sr QPD X budeprion xl QPD X bupropion hcl/sr QPD X bupropion xl QPD X mirtazapine QPD X hcl X trazodone hcl X venlafaxine QPD X venlafaxine hcl er QPD X CYMBALTA ST/QPD X generic venlafaxine, PRISTIQ ER ST/QPD X CYMBALTA SAVELLA QPD X CYMBALTA 5.6 ANTIVERTIGO AND ANTIEMETIC DRUGS dronabinol X granisetron QPD X hcl X ondansetron hcl/odt QPD X prochlorperazine maleate X promethazine hcl X ANZEMET QPD X ondansetron, granisetron EMEND CAPSULES QPD X TRANSDERM-SCOP X 5.7.1 ANTIPARKINSON DRUGS benztropine mesylate X trihexyphenidyl hcl X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES 5.7.2 OTHER ANTIPARKINSON DRUGS carbidopa-levodopa X carbidopa-levodopa-entacapone X entacapone X pramipexole dihydrochloride X ropinirole hcl QPD X selegiline hcl X AZILECT X COMTAN X MIRAPEX ER X pramipexole REQUIP XL QPD X ropinirole carbidopa-levodopa- STALEVO X entacapone 5.8 ANTIPSYCHOTIC DRUGS clozapine X fluphenazine hcl X haloperidol X olanzapine/odt QPD X perphenazine X quetiapine fumarate QPD X risperidone/odt X thioridazine hcl X thiothixene X trifluoperazine hcl X ziprasidone hcl QPD X haloperidol, olanzapine/odt, risperidone/odt, SEROQUEL ABILIFY/DISCMELT QPD X XR GEODON QPD X ziprasidone hcl haloperidol, olanzapine/odt, risperidone/odt, SEROQUEL LATUDA QPD X XR RISPERDAL CONSTA X haloperidol SEROQUEL PA/QPD X quetiapine fumarate SEROQUEL XR QPD X ZYPREXA/ZYDIS QPD X olanzapine/odt 5.9.1 CNS STIMULANT DRUGS amphetamine salt combo X dexmethylphenidate hcl X dextroamp-amphet er X dextroamphetamine sulfate X methylin er X methylphenidate er X methylphenidate hcl X modafinil PA X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES

ADDERALL 7.5MG, 12.5MG, 15MG X dextroamp-amphet/er ADDERALL 5MG, 10MG, 20MG, 30MG/ XR X dextroamp-amphet/er CONCERTA X methylphenidate er methylphenidate er, FOCALIN DAYTRANA QPD X XR, VYVANSE FOCALIN XR X

METADATE CD X methylphenidate er NUVIGIL PA/QPD X PROVIGIL PA X modafinil VYVANSE QPD X 5.9.2 OTHER CNS/AUTONOMIC DRUGS atropine sulfate X naltrexone hcl X pyridostigmine bromide X CAMPRAL X NUEDEXTA QPD X XYREM SP X 5.9.3 ANTIDEMENTIA DRUGS donepezil hcl QPD X galantamine hbr QPD X rivastigmine QPD X ARICEPT 5MG, 10MG/ODT QPD X donepezil hcl

ARICEPT 23MG TABS QPD X EXELON patches QPD X NAMENDA TABLETS X NAMENDA SOLUTION X NAMENDA TABLETS RAZADYNE ER QPD X galantamine hbr 5.9.4 DRUGS TO TREAT MULTIPLE SCLEROSIS AMPYRA PA/QPD/SP X GILENYA PA/QPD/SP X 5.9.6 OTHER DRUGS FOR ADHD INTUNIV QPD X KAPVAY X STRATTERA X CHAPTER 6: DERMATOLOGICAL MEDICATIONS 6.1 TOPICAL CORTICOSTEROID DRUGS betamethasone dipropionate X X propionate X X X X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES propionate X halobetasol propionate X valerate X furoate X X CAPEX SHAMPOO ST X CLOBEX SPRAY ST X HALOG ST X fluocinonide

LOCOID LIPOCREAM ST X

PRAMOSONE 2.5% OINTMENT ST X hydrocortisone-pramoxine PRAMOSONE 1% CREAM, LOTION, OINTMENT, 2.5% CREAM, LOTION ST X hydrocortisone-pramoxine PRAMOSONE E 2.5% CREAM ST X

ULTRAVATE PAC CREAM ST X halonate pac combo pack

ULATRAVATE PAC OINTMENT ST X halonate pac combo pack 6.2 ANTIPRURITIC DRUGS hydroxyzine hcl X hydroxyzine pamoate X 6.3 ANTIACNE DRUGS benzoyl peroxide X clindamycin-benzoyl peroxide X clindamycin phosphate X erythromycin-benzoyl peroxide X metronidazole 0.75% X sodium sulfacetamide/sulfur X tretinoin PA X ACANYA ST X

ATRALIN PA X tretinoin, DIFFERIN, EPIDUO DIFFERIN 0.3% GEL X DIFFERIN 0.1% LOTION X DIFFERIN 0.1% CREAM, GEL X adapalene clindamycin-benzoyl peroxide, DUAC ST X ACANYA, ZIANA EPIDUO ST X FINACEA X FINACEA PLUS X FINACEA METROGEL TOPICAL ST X NORITATE X metronidazole topical ZIANA PA/ST X 6.7 KERATOLYTIC DRUGS podofilox topical solution X CONDYLOX GEL X CONDYLOX TOPICAL SOLUTION X podofilox topical solution TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES 6.8 ANTIPSORIASIS AND ANTIECZEMA DRUGS calcipotriene X sulfacetamide sodium X DOVONEX CREAM X TACLONEX/SCALP X betamethasone+calcipotriene TAZORAC X tretinoin VECTICAL X 6.9.2 TOPICAL DERMATOLOGICAL DRUGS imiquimod X tretinoin PA X clobetasol propionate, ELIDEL X PROTOPIC X clobetasol propionate SANTYL X SOLARAZE X VEREGEN QPD X ZYCLARA QPD X imiquimod 6.9.3 SCABICIDES X EURAX X ULESFIA X 6.9.5 TOPTICAL ANTI-INFLAMMATORY DRUGS FLECTOR ST/QPD X PENNSAID ST/QPD X VOLTAREN ST X CHAPTER 7: EAR-NOSE-THROAT MEDICATIONS 7.1 DRUGS AFFECTING THE EAR acetic acid-hydrocortisone X antipyrine- X -polymyxin hc X ofloxacin otic X CIPRO HC X neomycin/polymyxin/hc CIPRODEX OTIC X 7.2 DRUGS AFFECTING THE NOSE QPD X nasal spray QPD X fluticasone nasal spray QPD X X triamcinolone acetonide nasal spray QPD X ASTEPRO ST/QPD X BECONASE AQ ST/QPD X fluticasone, OMNARIS NASONEX ST/QPD X fluticasone, OMNARIS OMNARIS ST/QPD X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES PATANASE ST/QPD X azelastine RHINOCORT AQUA ST/QPD X fluticasone, OMNARIS VERAMYST ST/QPD X fluticasone, OMNARIS 7.3 DRUGS AFFECTING THE THROAT AND MOUTH doxycycline hyclate X EVOXAC X CHAPTER 8: ENDOCRINE MEDICATIONS 8.1.1 INSULIN HUMALOG, HUMULIN, APIDRA/SOLOSTAR X NOVOLIN, NOVOLOG HUMALOG Products X HUMULIN Products X LANTUS/SOLOSTAR X LEVEMIR X NOVOLIN Products X NOVOLOG Products X 8.1.2 ORAL HYPOGLYCEMIC DRUGS acarbose X glimepiride X glipizide QPD X glipizide er/xl QPD X glipizide-metformin QPD X glyburide X glyburide-metformin QPD X glyburide micronized X metformin hcl QPD X metformin hcl er QPD X nateglinide X PRANDIMET X PRANDIN X nateglinide 8.1.3 INSULIN SENSITIZERS pioglitazone QPD X pioglitazone-metformin QPD X ACTOPLUS MET ST/QPD X pioglitazone-metformin ACTOPLUS MET XR ST/QPD X ACTOS ST/QPD X pioglitazone pioglitazone-metformin, AVANDAMET ST/QPD X ACTOPLUS MET XR AVANDARYL ST/QPD X DUETACT AVANDIA ST/QPD X pioglitazone DUETACT ST/QPD X 8.1.4 AMYLIN ANALOGUES SYMLIN/SYMLINPEN PA/QPD X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES 8.1.5.1 INCRETIN MIMETICS BYDUREON PA/QPD X BYETTA PA/QPD X VICTOZA PA/QPD X 8.1.5.2 DIPEPTIDYL PEPTIDASE-IV INHIB JANUMET/XR ST/QPD X JANUVIA ST/QPD X JUVISYNC ST/QPD X KOMBIGLYZE XR ST/QPD X ONGLYZA ST/QPD X TRADJENTA ST/QPD X JANUVIA, ONGLYZA 8.3.1 DRUGS (injectable) X dexamethasone (non-injectable) X hydrocortisone X X /sodium acetate X X veripred 20 X ORAPRED ODT X prednisolone sodium acetate 8.3.2 MINERALOCORTICOID DRUGS acetate X 8.4.1 THYROID SUPPLEMENTS sodium X levoxyl X thyroid X unithroid X ARMOUR THYROID 15MG,120MG, 180MG, 240MG, 300MG X thyroid ARMOUR THYROID 30MG, 60MG, 90MG X thyroid SYNTHROID X 8.4.2 ANTITHYROID DRUGS methimazole X 8.6 OTHER ENDOCRINE DRUGS alendronate sodium QPD X desmopressin injection X fortical nasal spray QPD X ibandronate sodium QPD X alendronate sodium, ACTONEL ST/QPD X ibandronate sodium alendronate sodium, ATELVIA ST/QPD X ibandronate sodium BONIVA TABLETS ST/QPD X ibandronate sodium BONIVA INJECTION PA/QPD/SP X alendronate sodium TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES DDAVP 0.01% NASAL SPRAY X desmopressin FORTEO PA/QPD/SP X FOSAMAX PLUS D ST/QPD X CHAPTER 9: GASTROINTESTINAL MEDICATIONS 9.2 ANTIDIARRHEAL DRUGS diphenoxylate-atropine X loperamide hcl X 9.3 ANTISPASMODICS/DRUGS AFFECT GI MOTILITY dicyclomine hcl X glycopyrrolate X hyoscyamine sulfate X metoclopramide hcl X 9.4 ANTIULCER DRUGS cimetidine X famotidine X nizatidine X ranitidine QPD X 9.4.1 OTHER ANTIULCER DRUGS misoprostol X sucralfate X CARAFATE X sucralfate 9.4.2 PROTON PUMP INHIBITORS lansoprazole QPD X QPD X omeprazole-sodium bicarbonate QPD X pantoprazole sodium QPD X ACIPHEX ST/QPD X omeprazole, NEXIUM DEXILANT ST/QPD X omeprazole, NEXIUM NEXIUM ST/QPD X

PREVACID ST/QPD X lansoprazole

ZEGERID PACKETS ST/QPD X omeprazole, NEXIUM 9.5 LAXATIVES AND CATHARTICS polyethylene glycol 3350 X 9.6 OTHER GI DRUGS anucort-hc X ec X gavilyte-g X X proctosol-hc X proctozone-hc X sulfasalazine X ursodiol X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES ANALPRAM HC 1% CREAM SINGLES, 2.5% LOTION X ASACOL X ASACOL HD X ASACOL CANASA X CREON DR X sulfasalazine, ASACOL, DIPENTUM X LIALDA LIALDA X MOVIPREP X peg 3350/electrolyte

PANCRELIPASE 5,000 X CREON/DR balsalazide disodium, PENTASA X ASACOL, LIALDA PROCTOFOAM-HC X SUPREP X

9.7 IRRITABLE BOWEL AMITIZA QPD X CHAPTER 10: IMMUNOLOGICALS AND VACCINES 10.2.2 ERYTHROID STIMULANTS PROCRIT PA/QPD/SP X 10.2.3 INTERFERONS AVONEX/ADMIN PACK/PEN QPD/SP X BETASERON QPD/SP X COPAXONE QPD/SP X PEGASYS/PROCLICK PA/QPD/SP X PEGINTRON/REDIPEN PA/QPD/SP X REBIF QPD/SP X 10.2.4 GROWTH HORMONES AND RELATED DRUGS HUMATROPE, NUTROPIN/AQ, GENOTROPIN PA/SP X OMNITROPE

HUMATROPE PA/SP X HUMATROPE, NUTROPIN/AQ, NORDITROPIN PA/SP X OMNITROPE NUTROPIN PA/SP X NUTROPIN AQ, -NUSPIN PA/SP X OMNITROPE PA/SP X HUMATROPE, NUTROPIN/AQ, SAIZEN PA/SP X OMNITROPE HUMATROPE, NUTROPIN/AQ, TEV-TROPIN PA/SP X OMNITROPE CHAPTER 11: MUSCULOSKELETAL MEDICATIONS 11.1.1 SALICYLATES AND RELATED DRUGS diflunisal X 11.1.2 NON-STEROIDAL ANTIINFLAMMATORY AGENTS diclofenac potassium X diclofenac sodium X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES etodolac X flurbiprofen X ibuprofen X indomethacin X ketoprofen X ketorolac tromethamine injectable X ketorolac tromethamine oral QPD X meloxicam QPD X nabumetone X naproxen/sodium X oxaprozin X piroxicam X sulindac X CAMBIA ST/QPD X CELEBREX ST/QPD X meloxicam 11.2 DRUGS TO PREVENT AND TREAT GOUT allopurinol X colchicine X COLCRYS X ULORIC QPD X 11.3.1 DIRECT MUSCLE RELAXANTS baclofen X tizanidine hcl X 11.3.2 CNS MUSCLE RELAXANTS carisoprodol QPD X chlorzoxazone X cyclobenzaprine hcl X metaxalone X methocarbamol X orphenadrine citrate injectable X orphenadrine citrate oral X SKELAXIN X metaxalone CHAPTER 12: NUTRITION,BLOOD 12.1.2 VITAMINS & MINERALS & RELATED multivitamins with fluoride X BACMIN X 12.1.3 THERAPEUTIC VITAMINS & MINERALS calcitriol X folic acid X vitamin d2 X NASCOBAL X ZEMPLAR CAPSULE X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES 12.1.4 FLUORIDE PRODUCTS fluoride X PREVIDENT X sodium fluoride 12.2 POTASSIUM SUPPLEMENTS klor-con 10/m10/m20 X potassium chloride X 12.3.1 ORAL ANTICOAGULANTS, VITAMIN K warfarin sodium X COUMADIN X 12.3.2 INJECTABLE ANTICOAGULANTS enoxaparin sodium X fondaparinux sodium X sodium X ARIXTRA X FRAGMIN X 12.3.5 THROMBIN INHIBITORS PRADAXA QPD X 12.4 ANTIPLATELET DRUGS cilostazol QPD X clopidogrel QPD X ticlopidine hcl QPD X AGGRENOX QPD X BRILINTA QPD X EFFIENT QPD X PLAVIX QPD X clopidogrel 12.7 BLOOD DETOXICANTS enulose X lactulose X FOSRENOL X KRISTALOSE X lactulose RENAGEL X RENVELA X CHAPTER 13: OBSTETRICAL & GYNECOLOGICAL MEDICATIONS 13.1.1 PRENATAL VITAMINS prenatal plus X zatean-pn plus X TRICARE PRENATAL DHA ONE X VITAFOL-ONE X 13.1.2 SPECIALIZED OB/GYN DRUGS LUPRON DEPOT X

13.1.3 OB/GYN TOPICAL ANTIINFECTIVES clindamycin phosphate - vaginal X metronidazole - vaginal X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES vandazole X 13.3 ANDROGEN DRUGS testosterone cypionate injectable X

ANDRODERM PA/QPD X ANDROGEL, AXIRON, TESTIM ANDROGEL PA/QPD X AXIRON PA/QPD X DEPO-TESTOSTERONE X testosterone cypionate

FORTESTA PA/QPD X ANDROGEL, AXIRON, TESTIM

STRIANT PA/QPD X ANDROGEL, AXIRON, TESTIM TESTIM PA/QPD X 13.4 ESTROGEN DRUGS estradiol X estradiol transdermal patch QPD X estrogen & methyltestosterone X estropipate X estradiol, estropipate, CENESTIN X PREMARIN CLIMARA QPD X estradiol patch DIVIGEL QPD X ESTROGEL, EVAMIST estradiol, estropipate, ENJUVIA X PREMARIN ESTRACE - VAGINAL X estradiol ESTRASORB QPD X ESTROGEL, EVAMIST ESTRING QPD X ESTROGEL QPD X EVAMIST QPD X FEMRING QPD X estradiol, estropipate, MENEST X PREMARIN PREMARIN QPD X VAGIFEM X ESTRING VIVELLE-DOT QPD X 13.4.1 ESTROGEN/PROGESTIN COMBINATIONS

estradiol-norethindrone acetate X

jinteli X CLIMARA PRO QPD X COMBIPATCH QPD X CLIMARA PRO

FEMHRT 1MG-5 MCG X jinteli estradiol-norethindrone, FEMHRT 0.5MG-2.5MCG X PREMPHASE, PREMPRO PREFEST X PREMPHASE QPD X PREMPRO QPD X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES 13.4.3 SELECTIVE ESTROGEN RECEPTOR MODULATOR

EVISTA QPD X 13.5 PROGESTIN DRUGS camila X errin X jolivette X acetate injection QPD X medroxyprogesterone acetate oral X nora-be X norethindrone acetate X (oral) X CRINONE 4% X ENDOMETRIN X CRINONE 4% MAKENA PA/QPD/SP X PROMETRIUM X progesterone 13.7 CONTRACEPTIVES altavera X apri X aviane X azurette X balziva X camrese QPD X cryselle X enpresse X gianvi X gildess fe X jolessa QPD X junel fe X kariva X kelnor 1-35 X lessina X levora-28 X loryna X low-ogestrel X lutera X microgestin X microgestin fe X mononessa X necon X nortrel X ocella X ogestrel X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES portia X previfem X reclipsen X sprintec X syeda X tilia fe X tri-legest fe X trinessa X tri-previfem X tri-sprintec tablet X trivora-28 X zarah X zenchent X BEYAZ X generics for YAZ, YASMIN LOESTRIN 24 FE X microgestin fe LO LOESTRIN FE X microgestin fe LOSEASONIQUE QPD X generics LYBREL X amethyst NUVARING X generics ORTHO EVRA X generics ORTHO TRI-CYCLEN X ORTHO TRI-CYCLEN LO X generics SAFYRAL X generics CHAPTER 14: OPHTHALMIC MEDICATIONS 14.1.1 OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS bacitracin X ciprofloxacin 0.3% X erythromycin X gentamicin sulfate X levofloxacin X ofloxacin 0.3% X polymyxin b sul/trimethoprim X sulfacetamide sodium X tobramycin sulfate X ciprofloxacin 0.3%, ofloxacin BESIVANCE X 0.3%, MOXEZA, VIGAMOX

MOXEZA X

VIGAMOX X ciprofloxacin 0.3%, ofloxacin ZYMAXID X 0.3%, MOXEZA, VIGAMOX 14.1.2 OPHTHALMIC TOPICAL ANTIVIRAL DRUGS trifluridine X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES 14.2 OPHTHALMIC CORTICOSTEROID DRUGS dexamethasone sodium phosphate X X X ALREX X fluorometholone, prednisolone acetate, DUREZOL X LOTEMAX fluorometholone, prednisolone acetate, FML FORTE X LOTEMAX LOTEMAX DROPS X LOTEMAX OINTMENT X fluorometholone, prednisolone acetate, VEXOL X LOTEMAX 14.3 OPHTHALMIC ANTIINFECTIVE/ neomycin-polymyxin-dexameth X neomycin-polymyxin-hc X tobramycin-dexamethasone X TOBRADEX (ointment) X TOBRADEX ST X tobramycin-dexamethasone 14.5 ANTIGLAUCOMA DRUGS acetazolamide X betaxolol X brimonidine tartrate X dorzolamide-timolol X latanoprost PA X levobunolol hcl X pilocarpine hcl X timolol maleate X ALPHAGAN P 0.1% X ALPHAGAN P 0.15% X brimonidine tartrate dorzolamide hcl, AZOPT X ALPHAGAN P 0.1% BETOPTIC S X betaxolol COMBIGAN X brimonidine + timolol ISTALOL X ALPHAGAN P 0.1% LUMIGAN PA X TRAVATAN Z PA X 14.6 OTHER OPHTHALMIC DRUGS

atropine sulfate X

cromolyn sodium X

diclofenac sodium X ketorolac tromethamine X BROMDAY X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES ketorolac tromethamine, NEVANAC X bromfenac sodium, BROMDAY PATADAY X PATANOL PATANOL X RESTASIS QPD X CHAPTER 15: RESPIRATORY MEDICATIONS 15.1.1 BETA-2 ADRENERGIC DRUGS albuterol sulfate QPD X levalbuterol hcl X sulfate X BROVANA QPD X FORADIL QPD X PROAIR HFA QPD X

PROVENTIL HFA QPD X PROAIR HFA, VENTOLIN HFA SEREVENT DISKUS QPD X FORADIL VENTOLIN HFA QPD X

XOPENEX X levalbuterol

XOPENEX HFA QPD X PROAIR HFA, VENTOLIN HFA 15.1.2 METHYL DRUGS X anhydrous X theophylline er X 15.1.3 OTHER DRUGS FOR budesonide QPD X cromolyn sodium solution X ipratropium bromide solution X ipratropium-albuterol QPD X ADVAIR DISKUS QPD X ADVAIR HFA QPD X

ALVESCO QPD X FLOVENT, PULMICORT, QVAR

ASMANEX QPD X FLOVENT, PULMICORT, QVAR ATROVENT HFA INHALER QPD X COMBIVENT QPD X

DULERA QPD X FLOVENT, PULMICORT, QVAR EPIPEN/JR X FLOVENT DISKUS QPD X FLOVENT HFA QPD X PULMICORT/FLEXHALER QPD X QVAR QPD X SPIRIVA QPD X SYMBICORT QPD X TWINJECT X TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES 15.1.4 LEUKOTRIENE MODIFIERS sodium QPD X X SINGULAIR ST/QPD X montelukast sodium 15.2.1 cyproheptadine hcl X desloratadine QPD X fexofenadine hcl QPD X levocetirizine dihydrochloride QPD X promethazine vc X CLARINEX ST/QPD X desloratadine 15.2.3 / COMBINATIONS azelastine, fexofenadine, CLARINEX-D ST/QPD X fluticasone POLY HIST FORTE X 15.3 ANTITUSSIVE AND EXPECTORANT DRUGS benzonatate X cheratussin ac X guaifenesin w/codeine X guaifenex pse X hydrocodone-chlorpheniramine X hydrocodone-homatropine mbr X hydromet X promethazine-codeine X promethazine-dm X promethazine vc-codeine X pseudovent dm X BROMFED DM X J-COF DHC X J-TAN D X

MAR-COF CG/BP X ZUTRIPRO X

15.4 OTHER RESPIRATORY DRUGS DALIRESP X CHAPTER 16: UROLOGICAL MEDICATIONS 16.1.1 ANTICHOLINERGIC ANTISPASMODICS oxybutynin chloride X oxybutynin chloride er QPD X tolterodine tartrate QPD X trospium chloride QPD X

DETROL ST/QPD X tolterodine tartrate oxybutynin er, tolterodine, trospium, ENABLEX, DETROL LA ST/QPD X GELNIQUE, SANCTURA XR TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES ENABLEX ST/QPD X

GELNIQUE ST/QPD X oxybutynin er, tolterodine, trospium, ENABLEX, OXYTROL ST/QPD X GELNIQUE, SANCTURA XR

SANCTURA XR ST/QPD X oxybutynin er, tolterodine, trospium, ENABLEX, TOVIAZ ST/QPD X GELNIQUE, SANCTURA XR oxybutynin er, tolterodine, trospium, ENABLEX, VESICARE ST/QPD X GELNIQUE, SANCTURA XR 16.1.3 URINARY ANESTHETICS phenazopyridine hcl X 16.1.4 OTHER GENITOURINARY PRODUCTS alfuzosin hcl X finasteride QPD X tamsulosin hcl QPD X AVODART QPD X finasteride JALYN QPD X

RAPAFLO QPD X finasteride

UROXATRAL X alfuzosin 18.1 DIABETIC SUPPLIES

ACCU-CHEK TEST STRIPS X

ASCENSIA AUTODISC STRIPS X

ASCENSIA ELITE TEST STRIPS X

BREEZE 2 DISC TEST STRIPS X

CONTOUR TEST STRIPS X

PA ACCU-CHEK, ASCENSIA, FAST TAKE TEST STRIPS X BREEZE, CONTOUR

PA ACCU-CHEK, ASCENSIA, FREESTYLE TEST STRIPS X BREEZE, CONTOUR NOVOFINE 32 X NOVOFINE X

ONE TOUCH LANCETS X ACCU-CHEK, ASCENSIA, ONE TOUCH TEST STRIPS PA X BREEZE, CONTOUR ONE TOUCH ULTRA TEST ACCU-CHEK, ASCENSIA, STRIPS PA X BREEZE, CONTOUR PRECISION Q-I-D, -PCX TEST ACCU-CHEK, ASCENSIA, STRIPS PA X BREEZE, CONTOUR PRECISION SOF-TACT TEST ACCU-CHEK, ASCENSIA, STRIPS PA X BREEZE, CONTOUR ACCU-CHEK, ASCENSIA, PRECISION XTRA TEST STRIPS PA X BREEZE, CONTOUR PRODIGY INSULIN SYRINGE X PRODIGY PEN NEEDLE X SOFT TOUCH LANCETS X ACCU-CHEK, ASCENSIA, SURESTEP TEST STRIPS PA X BREEZE, CONTOUR TIER RECOMMENDED DRUG NAME PA/QPD/SP/ST 1 2 3 4 5 ALTERNATIVES ACCU-CHEK, ASCENSIA, TRUETEST TEST STRIPS PA X BREEZE, CONTOUR

PA ACCU-CHEK, ASCENSIA, TRUETRACK TEST STRIPS X BREEZE, CONTOUR

Index

ABILIFY/DISCMELT 5.8 ANZEMET 5.6 ABSTRAL 5.1.1.1 apap/cafffeine/butalbital 5.1.2 ACANYA 6.3 APIDRA/SOLOSTAR 8.1.1 acarbose 8.1.2 apri 13.7 ACCU‐CHEK TEST STRIPS 18.1 ARICEPT 23MG TABS 5.9.3 acebutolol hcl 4.4 ARICEPT 5MG, 10MG/ODT 5.9.3 acetaminophen‐codeine 5.1.1.2 ARIMIDEX 3 acetazolamide 14.5 ARIXTRA 12.3.2 acetic acid‐hydrocortisone 7.1 ARMOUR THYROID 15MG,120MG, 8.4.1 ACIPHEX 9.4.2 180MG, 240MG, 300MG ACTONEL 8.6 ARMOUR THYROID 30MG, 60MG, 90MG 8.4.1 ACTOPLUS MET 8.1.3 ASACOL 9.6 ACTOPLUS MET XR 8.1.3 ASACOL HD 9.6 ACTOS 8.1.3 ASCENSIA AUTODISC STRIPS 18.1 acyclovir 2.5.2 ASCENSIA ELITE TEST STRIPS 18.1 ADCIRCA 4.6.2 ASMANEX 15.1.3 ADDERALL 5MG, 10MG, 20MG, 30MG/ 5.9.1 aspirin/caffeine/butalbital 5.1.2 XR ASTEPRO 7.2 ADDERALL 7.5MG, 12.5MG, 15MG 5.9.1 ATACAND 4.5.4.2 ADVAIR DISKUS 15.1.3 ATACAND HCT 4.5.6 ADVAIR HFA 15.1.3 ATELVIA 8.6 AGGRENOX 12.4 atenolol 4.4 albuterol sulfate 15.1.1 atenolol‐chlorthalidone 4.5.6 alendronate sodium 8.6 atorvastatin calcium 4.8.2 alfuzosin hcl 16.1.4 ATRALIN 6.3 allopurinol 11.2 ATRIPLA 2.5.1 ALPHAGAN P 0.1% 14.5 atropine sulfate 14.6 ALPHAGAN P 0.15% 14.5 atropine sulfate 5.9.2 alprazolam/er/xr/odt 5.2.1 ATROVENT HFA INHALER 15.1.3 ALREX 14.2 AUGMENTIN 125‐31.25MG (Suspension) 2.1.5 ALTABAX 2.2 AUGMENTIN ES/XR 2.1.5 altavera 13.7 AVALIDE 4.5.6 ALTOPREV 4.8.2 AVANDAMET 8.1.3 ALVESCO 15.1.3 AVANDARYL 8.1.3 AMBIEN/CR 5.2.2 AVANDIA 8.1.3 aminophylline 15.1.2 AVAPRO 4.5.4.2 amiodarone hcl 4.7.3 AVELOX/ABC PACK 2.1.9 AMITIZA 9.7 aviane 13.7 amitriptyline hcl 5.5.1.1 AVINZA 5.1.1.1 amlodipine besylate 4.2 AVODART 16.1.4 amlodipine besylate‐benazepril 4.5.6 AVONEX/ADMIN PACK/PEN 10.2.3 amlodipine‐atorvastatin 4.8.2.1 AXIRON 13.3 amox tr/potassium clavulanate 2.1.5 azathioprine 3 amoxicillin 2.1.5 azelastine 7.2 amoxicillin‐clavulanate er 2.1.5 AZILECT 5.7.2 amphetamine salt combo 5.9.1 azithromycin 2.1.4.1 ampicillin trihydrate 2.1.5 AZOPT 14.5 AMPYRA 5.9.4 AZOR 4.5.6 ANALPRAM HC 1% CREAM SINGLES, 2.5% 9.6 azurette 13.7 LOTION bacitracin 2.8 anastrozole 3 bacitracin 14.1.1 ANDRODERM 13.3 baclofen 11.3.1 ANDROGEL 13.3 BACMIN 12.1.2 ANTARA 4.8.1 BACTROBAN CREAM 2.2 antipyrine‐benzocaine 7.1 BACTROBAN NASAL OINTMENT 2.2 anucort‐hc 9.6 balziva 13.7 CEDAX 2.1.1 BARACLUDE 2.5.2 cefaclor 2.1.1 BECONASE AQ 7.2 cefadroxil 2.1.1 benazepril hcl 4.5.4.1 cefdinir 2.1.1 benazepril‐hctz 4.5.6 cefpodoxime 2.1.1 BENICAR 4.5.4.2 cefprozil 2.1.1 BENICAR HCT 4.5.6 cefuroxime 2.1.1 benzonatate 15.3 CELEBREX 11.1.2 benzoyl peroxide 6.3 CELONTIN 5.4.5 benztropine mesylate 5.7.1 CENESTIN 13.4 BESIVANCE 14.1.1 cephalexin 2.1.1 betamethasone dipropionate 6.1 cheratussin ac 15.3 betamethasone valerate 6.1 chlordiazepoxide hcl 5.2.1 BETASERON 10.2.3 chlorthalidone 4.3.2 betaxolol 14.5 chlorzoxazone 11.3.2 BETOPTIC S 14.5 cholestyramine 4.8.1 BEYAZ 13.7 ciclopirox 2.4.2 bisoprolol fumarate 4.4 cilostazol 12.4 bisoprolol fumarate‐hctz 4.5.6 cimetidine 9.4 BONIVA INJECTION 8.6 CIMZIA 3 BONIVA TABLETS 8.6 CIPRO HC 7.1 BREEZE 2 DISC TEST STRIPS 18.1 CIPRODEX OTIC 7.1 BRILINTA 12.4 ciprofloxacin 0.3% 14.1.1 brimonidine tartrate 14.5 ciprofloxacin hcl, ‐ er 2.1.9 BROMDAY 14.6 citalopram hbr 5.5.1.3 BROMFED DM 15.3 CLARINEX 15.2.1 BROVANA 15.1.1 CLARINEX‐D 15.2.3 budeprion sr 5.5.1.4 clarithromycin, ‐er 2.1.4.1 budeprion xl 5.5.1.4 CLIMARA 13.4 budesonide 15.1.3 CLIMARA PRO 13.4.1 budesonide ec 9.6 clindamycin hcl 2.1.3 bumetanide 4.3.1 clindamycin palmitate hcl 2.1.3 buprenorphine hcl 5.1.1.2 clindamycin phosphate 6.3 bupropion hcl/sr 5.5.1.4 clindamycin phosphate ‐ vaginal 13.1.3 bupropion xl 5.5.1.4 clindamycin‐benzoyl peroxide 6.3 buspirone hcl 5.2.1 clobetasol propionate 6.1 butorphanol tartrate nasal spray 5.1.2 CLOBEX SPRAY 6.1 BUTRANS 5.1.1.2 clomipramine hcl 5.5.1.1 BYDUREON 8.1.5.1 clonazepam 5.4.2 BYETTA 8.1.5.1 clonidine hcl 4.5.2 BYSTOLIC 4.4 clonidine patch 4.5.2 CADUET 4.8.2.1 clopidogrel 12.4 calcipotriene 6.8 clorazepate dipotassium 5.2.1 calcitriol 12.1.3 clotrimazole 2.4.1 CAMBIA 11.1.2 clotrimazole 2.4.2 camila 13.5 clotrimazole/betamethasone 2.4.3 CAMPRAL 5.9.2 clozapine 5.8 camrese 13.7 colchicine 11.2 CANASA 9.6 COLCRYS 11.2 candesartan cilexetil‐hctz 4.5.6 colestipol hcl 4.8.1 CAPEX SHAMPOO 6.1 COMBIGAN 14.5 captopril 4.5.4.1 COMBIPATCH 13.4.1 captopril‐hctz 4.5.6 COMBIVENT 15.1.3 CARAFATE 9.4.1 COMBIVIR 2.5.1 carbamazepine/xr 5.4.1 COMPLERA 2.5.1 carbidopa‐levodopa 5.7.2 COMTAN 5.7.2 carbidopa‐levodopa‐entacapone 5.7.2 CONCERTA 5.9.1 carisoprodol 11.3.2 CONDYLOX GEL 6.7 cartia xt 4.2 CONDYLOX TOPICAL SOLUTION 6.7 carvedilol 4.4 CONTOUR TEST STRIPS 18.1 COPAXONE 10.2.3 DUAC 6.3 COREG CR 4.4 DUETACT 8.1.3 COUMADIN 12.3.1 DULERA 15.1.3 CREON DR 9.6 DUREZOL 14.2 CRESTOR 4.8.2 DYNACIRC CR 4.2 CRINONE 4% 13.5 econazole nitrate 2.4.2 cromolyn sodium 14.6 EDARBI 4.5.4.2 cromolyn sodium solution 15.1.3 EFFIENT 12.4 cryselle 13.7 ELIDEL 6.9.2 cyclobenzaprine hcl 11.3.2 EMEND CAPSULES 5.6 cyclosporine (oral) 3 EMTRIVA 2.5.1 CYMBALTA 5.5.1.4 ENABLEX 16.1.1 cyproheptadine hcl 15.2.1 enalapril maleate 4.5.4.1 DALIRESP 15.4 enalapril maleate‐hctz 4.5.6 DAYTRANA 5.9.1 ENBREL 3 DDAVP 0.01% NASAL SPRAY 8.6 endocet 5.1.1.1 DEPAKOTE all forms 5.4.4 ENDOMETRIN 13.5 DEPO‐TESTOSTERONE 13.3 ENJUVIA 13.4 desloratadine 15.2.1 enoxaparin sodium 12.3.2 desmopressin injection 8.6 enpresse 13.7 desonide 6.1 entacapone 5.7.2 desoximetasone 6.1 enulose 12.7 DETROL 16.1.1 EPIDUO 6.3 DETROL LA 16.1.1 EPIPEN/JR 15.1.3 dexamethasone (injectable) 8.3.1 EPIVIR HBV 2.5.2 dexamethasone (non‐injectable) 8.3.1 EPIVIR SOLUTION 2.5.1 dexamethasone sodium phosphate 14.2 EPIVIR TABLETS 2.5.1 DEXILANT 9.4.2 eprosartan mesylate 4.5.4.2 dexmethylphenidate hcl 5.9.1 errin 13.5 dextroamp‐amphet er 5.9.1 erythromycin 14.1.1 dextroamphetamine sulfate 5.9.1 erythromycin 2.1.4 diazepam 5.2.1 erythromycin‐benzoyl peroxide 6.3 diclofenac potassium 11.1.2 escitalopram oxalate 5.5.1.3 diclofenac sodium 14.6 estazolam 5.2.2 diclofenac sodium 11.1.2 ESTRACE ‐ VAGINAL 13.4 dicyclomine hcl 9.3 estradiol 13.4 DIFFERIN 0.1% CREAM, GEL 6.3 estradiol transdermal patch 13.4 DIFFERIN 0.1% LOTION 6.3 estradiol‐norethindrone acetate 13.4.1 DIFFERIN 0.3% GEL 6.3 ESTRASORB 13.4 diflunisal 11.1.1 ESTRING 13.4 digoxin 4.1 ESTROGEL 13.4 DILANTIN 5.4.3 estrogen & methyltestosterone 13.4 diltiazem 24hr er/24hr cd 4.2 estropipate 13.4 diltiazem hcl/ er 4.2 ethosuximide 5.4.5 DIOVAN 4.5.4.2 etodolac 11.1.2 DIOVAN HCT 4.5.6 EURAX 6.9.3 DIPENTUM 9.6 EVAMIST 13.4 diphenoxylate‐atropine 9.2 EVISTA 13.4.3 divalproex sodium/er 5.4.4 EVOXAC 7.3 DIVIGEL 13.4 EXALGO 5.1.1.1 donepezil hcl 5.9.3 EXELON patches 5.9.3 DORYX DR 150MG 2.1.7 EXFORGE/HCT 4.5.6 dorzolamide‐timolol 14.5 famciclovir 2.5.2 DOVONEX CREAM 6.8 famotidine 9.4 doxazosin mesylate 4.5.1 FAST TAKE TEST STRIPS 18.1 doxepin hcl 5.5.1.1 felodipine er 4.2 doxycycline hyclate 7.3 FEMARA 3 doxycycline hyclate 2.1.7 FEMHRT 0.5MG‐2.5MCG 13.4.1 doxycycline monohydrate 2.1.7 FEMHRT 1MG‐5 MCG 13.4.1 dronabinol 5.6 FEMRING 13.4 fenofibrate 4.8.1 glyburide 8.1.2 FENOGLIDE 4.8.1 glyburide micronized 8.1.2 fentanyl oral transmucosal 5.1.1.1 glyburide‐metformin 8.1.2 fentanyl patch 5.1.1.1 glycopyrrolate 9.3 FENTORA 5.1.1.1 granisetron 5.6 fexofenadine hcl 15.2.1 guaifenesin w/codeine 15.3 FINACEA 6.3 guaifenex pse 15.3 FINACEA PLUS 6.3 guanfacine hcl 4.5.2 finasteride 16.1.4 halobetasol propionate 6.1 flecainide acetate 4.7.1.3 HALOG 6.1 FLECTOR 6.9.5 haloperidol 5.8 FLOVENT DISKUS 15.1.3 heparin sodium 12.3.2 FLOVENT HFA 15.1.3 HUMALOG Products 8.1.1 fluconazole 2.3 HUMATROPE 10.2.4 fludrocortisone acetate 8.3.2 HUMIRA 3 flunisolide nasal spray 7.2 HUMULIN Products 8.1.1 fluocinonide 6.1 hydralazine hcl 4.5.1 fluoride 12.1.4 hydrochlorothiazide 4.3.2 fluorometholone 14.2 hydrocodone bit‐ibuprofen 5.1.1.2 fluoxetine hcl 5.5.1.3 hydrocodone‐acetaminophen 5.1.1.2 fluphenazine hcl 5.8 hydrocodone‐chlorpheniramine 15.3 flurazepam hcl 5.2.2 hydrocodone‐homatropine mbr 15.3 flurbiprofen 11.1.2 hydrocortisone 8.3.1 flutamide 3 hydrocortisone acetate 9.6 fluticasone nasal spray 7.2 6.1 6.1 hydromet 15.3 fluvastatin 4.8.2 hydromorphone hcl 5.1.1.1 fluvoxamine maleate 5.5.1.3 hydroxychloroquine sulfate 2.7.3 FML FORTE 14.2 hydroxyzine hcl 6.2 FOCALIN XR 5.9.1 hydroxyzine pamoate 6.2 folic acid 12.1.3 hyoscyamine sulfate 9.3 fondaparinux sodium 12.3.2 ibandronate sodium 8.6 FORADIL 15.1.1 ibuprofen 11.1.2 FORTEO 8.6 imipramine hcl 5.5.1.1 FORTESTA 13.3 imipramine pamoate 5.5.1.1 fortical nasal spray 8.6 imiquimod 6.9.2 FOSAMAX PLUS D 8.6 IMITREX (NON‐INJ) 5.1.2 fosinopril sodium 4.5.4.1 IMITREX INJECTION 5.1.2 fosinopril‐hctz 4.5.6 INCIVEK 2.5.1 FOSRENOL 12.7 indapamide 4.3.2 FRAGMIN 12.3.2 indomethacin 11.1.2 FREESTYLE TEST STRIPS 18.1 INNOPRAN XL 4.4 FROVA 5.1.2 INTELENCE 2.5.1 furosemide 4.3.1 INTUNIV 5.9.6 FUZEON 2.5.1 ipratropium bromide 7.2 gabapentin 5.4.7 ipratropium bromide solution 15.1.3 galantamine hbr 5.9.3 ipratropium‐albuterol 15.1.3 gavilyte‐g 9.6 irbesartan 4.5.4.2 GELNIQUE 16.1.1 irbesartan‐hctz 4.5.6 gemfibrozil 4.8.1 isoniazid 2.7.2 GENOTROPIN 10.2.4 isosorbide dinitrate 4.6.1 gentamicin sulfate 14.1.1 isosorbide mononitrate er 4.6.1 GEODON 5.8 isradipine 4.2 gianvi 13.7 ISTALOL 14.5 gildess fe 13.7 itraconazole 2.3 GILENYA 5.9.4 JALYN 16.1.4 glimepiride 8.1.2 JANUMET/XR 8.1.5.2 glipizide 8.1.2 JANUVIA 8.1.5.2 glipizide er/xl 8.1.2 J‐COF DHC 15.3 glipizide‐metformin 8.1.2 jinteli 13.4.1 jolessa 13.7 LOCOID LIPOCREAM 6.1 jolivette 13.5 LOESTRIN 24 FE 13.7 J‐TAN D 15.3 loperamide hcl 9.2 junel fe 13.7 lorazepam 5.2.1 JUVISYNC 8.1.5.2 LORTAB 5.1.1.2 KADIAN ER 5.1.1.1 loryna 13.7 KAPVAY 5.9.6 losartan potassium 4.5.4.2 kariva 13.7 losartan‐hctz 4.5.6 kelnor 1‐35 13.7 LOSEASONIQUE 13.7 KEPPRA/XR 5.4.7 LOTEMAX DROPS 14.2 KETEK, ‐PAK 2.1.4.2 LOTEMAX OINTMENT 14.2 ketoconazole 2.3 lovastatin 4.8.2 ketoconazole 2.4.2 LOVAZA 4.8.1 ketoprofen 11.1.2 low‐ogestrel 13.7 ketorolac tromethamine 14.6 LUMIGAN 14.5 ketorolac tromethamine injectable 11.1.2 LUNESTA 5.2.2 ketorolac tromethamine oral 11.1.2 LUPRON DEPOT 13.1.2 KINERET 3 lutera 13.7 klor‐con 10/m10/m20 12.2 LUVOX CR 5.5.1.3 KOMBIGLYZE XR 8.1.5.2 LYBREL 13.7 KRISTALOSE 12.7 LYRICA 5.4.7 labetalol hcl 4.4 MAKENA 13.5 lactulose 12.7 MAR‐COF CG/BP 15.3 LAMICTAL ODT/XR 5.4.7 MAXALT 5.1.2 lamotrigine 5.4.7 MAXALT MLT 5.1.2 LANOXIN 4.1 meclizine hcl 5.6 lansoprazole 9.4.2 medroxyprogesterone acetate injection 13.5 LANTUS/SOLOSTAR 8.1.1 medroxyprogesterone acetate oral 13.5 latanoprost 14.5 meloxicam 11.1.2 LATUDA 5.8 MENEST 13.4 leflunomide 3 MEPRON 2.8 LESCOL 4.8.2 mercaptopurine 3 LESCOL XL 4.8.2 METADATE CD 5.9.1 lessina 13.7 metaxalone 11.3.2 LETAIRIS 4.6.3 metformin hcl 8.1.2 letrozole 3 metformin hcl er 8.1.2 levalbuterol hcl 15.1.1 methadone hcl 5.1.1.1 LEVAQUIN 2.1.9 methimazole 8.4.2 LEVEMIR 8.1.1 methocarbamol 11.3.2 levetiracetam 5.4.7 methotrexate (oral) 3 levobunolol hcl 14.5 methyldopa 4.5.2 levocetirizine dihydrochloride 15.2.1 methylin er 5.9.1 levofloxacin 14.1.1 methylphenidate er 5.9.1 levofloxacin 2.1.9 methylphenidate hcl 5.9.1 levora‐28 13.7 methylprednisolone 8.3.1 levothyroxine sodium 8.4.1 metoclopramide hcl 9.3 levoxyl 8.4.1 metolazone 4.3.2 LEXAPRO 5.5.1.3 metoprolol succ er 4.4 LEXIVA 2.5.1 metoprolol tartrate 4.4 LIALDA 9.6 METROGEL TOPICAL 6.3 lidocaine hcl viscous 1.2 metronidazole 2.7.5 lidocaine‐prilocaine 1.2 metronidazole ‐ vaginal 13.1.3 LIDODERM 1.2 metronidazole 0.75% 6.3 LIPITOR 4.8.2 mexiletine hcl 4.7.1.2 LIPOFEN 4.8.1 MICARDIS 4.5.4.2 lisinopril 4.5.4.1 MICARDIS HCT 4.5.6 lisinopril‐hctz 4.5.6 microgestin 13.7 lithium carbonate 5.3 microgestin fe 13.7 LIVALO 4.8.2 minocycline hcl 2.1.7 LO LOESTRIN FE 13.7 MIRAPEX ER 5.7.2 mirtazapine 5.5.1.4 NOVOLOG Products 8.1.1 misoprostol 9.4.1 NUCYNTA 5.1.1.1 modafinil 5.9.1 NUEDEXTA 5.9.2 moexipril hcl 4.5.4.1 NUTROPIN 10.2.4 moexipril‐hctz 4.5.6 NUTROPIN AQ, ‐NUSPIN 10.2.4 mometasone furoate 6.1 NUVARING 13.7 mononessa 13.7 NUVIGIL 5.9.1 montelukast sodium 15.1.4 nystatin 2.3 morphine sulfate/er 5.1.1.1 nystatin 2.4.1 MOVIPREP 9.6 nystatin 2.4.2 MOXATAG 2.1.5 nystatin w/triamcinolone 2.4.3 MOXEZA 14.1.1 ocella 13.7 MULTAQ 4.7.5 ofloxacin 2.1.9 multivitamins with fluoride 12.1.2 ofloxacin 0.3% 14.1.1 mupirocin 2% ointment 2.2 ofloxacin otic 7.1 MYCOBUTIN 2.7.2 ogestrel 13.7 mycophenolate (oral) 3 olanzapine/odt 5.8 nabumetone 11.1.2 omeprazole 9.4.2 nadolol 4.4 omeprazole‐sodium bicarbonate 9.4.2 nadolol‐bendroflumethiazide 4.5.6 OMNARIS 7.2 NAFTIN 2.4.2 OMNITROPE 10.2.4 naltrexone hcl 5.9.2 ondansetron hcl/odt 5.6 NAMENDA SOLUTION 5.9.3 ONE TOUCH LANCETS 18.1 NAMENDA TABLETS 5.9.3 ONE TOUCH TEST STRIPS 18.1 naproxen/sodium 11.1.2 ONE TOUCH ULTRA TEST STRIPS 18.1 naratriptan hcl 5.1.2 ONGLYZA 8.1.5.2 NASCOBAL 12.1.3 ONSOLIS 5.1.1.1 NASONEX 7.2 OPANA 5.1.1.1 nateglinide 8.1.2 OPANA ER 5.1.1.1 NEBUPENT 2.8 ORACEA 2.1.7 necon 13.7 ORAPRED ODT 8.3.1 nefazodone hcl 5.5.1.4 orphenadrine citrate injectable 11.3.2 neomycin‐polymyxin hc 7.1 orphenadrine citrate oral 11.3.2 neomycin‐polymyxin‐dexameth 14.3 ORTHO EVRA 13.7 neomycin‐polymyxin‐hc 14.3 ORTHO TRI‐CYCLEN 13.7 NEVANAC 14.6 ORTHO TRI‐CYCLEN LO 13.7 NEXAVAR 3 oxaprozin 11.1.2 NEXIUM 9.4.2 oxcarbazepine 5.4.1 NIASPAN ER 4.8.1 OXISTAT 2.4.2 nicardipine hcl 4.2 oxybutynin chloride 16.1.1 nifediac cc 4.2 oxybutynin chloride er 16.1.1 nifedical xl 4.2 oxycodone hcl 5.1.1.1 nifedipine er 4.2 oxycodone w/acetaminophen 5.1.1.1 nisoldipine 4.2 OXYCONTIN 5.1.1.1 nitrofurantoin 2.1.8 OXYTROL 16.1.1 nitrofurantoin mono‐macro 2.1.8 PANCRELIPASE 5,000 9.6 nitroglycerin 4.6.1 pantoprazole sodium 9.4.2 NITROSTAT 4.6.1 paroxetine hcl 5.5.1.3 nizatidine 9.4 PATADAY 14.6 nora‐be 13.5 PATANASE 7.2 NORDITROPIN 10.2.4 PATANOL 14.6 norethindrone acetate 13.5 PEGASYS/PROCLICK 10.2.3 NORITATE 6.3 PEGINTRON/REDIPEN 10.2.3 nortrel 13.7 penicillin v potassium 2.1.5 nortriptyline hcl 5.5.1.2 PENNSAID 6.9.5 NORVASC 4.2 PENTASA 9.6 NORVIR 2.5.1 perindopril erbumine 4.5.4.1 NOVOFINE 18.1 permethrin 6.9.3 NOVOFINE 32 18.1 perphenazine 5.8 NOVOLIN Products 8.1.1 phenazopyridine hcl 16.1.3 phenobarbital 5.4.6 propranolol hcl w/hctz 4.5.6 PHENYTEK 5.4.3 PROTOPIC 6.9.2 phenytoin 5.4.3 PROVENTIL HFA 15.1.1 phenytoin sodium extended 5.4.3 PROVIGIL 5.9.1 pilocarpine hcl 14.5 pseudovent dm 15.3 pindolol 4.4 PULMICORT/FLEXHALER 15.1.3 pioglitazone 8.1.3 pyridostigmine bromide 5.9.2 pioglitazone‐metformin 8.1.3 quetiapine fumarate 5.8 piroxicam 11.1.2 quinapril hcl 4.5.4.1 PLAVIX 12.4 quinapril‐hctz 4.5.6 podofilox topical solution 6.7 quinaretic 4.5.6 POLY HIST FORTE 15.2.3 quinidine gluconate cr/er 4.7.1.1 polyethylene glycol 3350 9.5 QVAR 15.1.3 polymyxin b sul/trimethoprim 14.1.1 ramipril 4.5.4.1 portia 13.7 RANEXA 4.9 potassium chloride 12.2 ranitidine 9.4 PRADAXA 12.3.5 RAPAFLO 16.1.4 pramipexole dihydrochloride 5.7.2 RAZADYNE ER 5.9.3 PRAMOSONE 1% CREAM, LOTION, 6.1 REBIF 10.2.3 OINTMENT, 2.5% CREAM, LOTION reclipsen 13.7 PRAMOSONE 2.5% OINTMENT 6.1 RELENZA 2.5.2 PRAMOSONE E 2.5% CREAM 6.1 RELPAX 5.1.2 PRANDIMET 8.1.2 RENAGEL 12.7 PRANDIN 8.1.2 RENVELA 12.7 pravastatin sodium 4.8.2 REQUIP XL 5.7.2 prazosin hcl 4.5.1 RESTASIS 14.6 PRECISION Q‐I‐D, ‐PCX TEST STRIPS 18.1 REVATIO 4.6.2 PRECISION SOF‐TACT TEST STRIPS 18.1 REVLIMID 3 PRECISION XTRA TEST STRIPS 18.1 REYATAZ 2.5.1 prednisolone acetate 14.2 RHINOCORT AQUA 7.2 prednisolone/sodium acetate 8.3.1 ribasphere 2.5.2 prednisone 8.3.1 ribavirin 2.5.2 PREFEST 13.4.1 rifampin 2.7.2 PREMARIN 13.4 rimantadine hcl 2.5.2 PREMPHASE 13.4.1 RISPERDAL CONSTA 5.8 PREMPRO 13.4.1 risperidone/odt 5.8 prenatal plus 13.1.1 rivastigmine 5.9.3 PREVACID 9.4.2 rizatriptan/odt 5.1.2 PREVIDENT 12.1.4 ropinirole hcl 5.7.2 previfem 13.7 roxicet 5.1.1.1 primidone 5.4.6 RYTHMOL SR 4.7.1.3 PRISTIQ ER 5.5.1.4 SAFYRAL 13.7 PROAIR HFA 15.1.1 SAIZEN 10.2.4 prochlorperazine maleate 5.6 SANCTURA XR 16.1.1 PROCRIT 10.2.2 SANTYL 6.9.2 PROCTOFOAM‐HC 9.6 SAVELLA 5.5.1.4 proctosol‐hc 9.6 selegiline hcl 5.7.2 proctozone‐hc 9.6 SEREVENT DISKUS 15.1.1 PRODIGY INSULIN SYRINGE 18.1 SEROQUEL 5.8 PRODIGY PEN NEEDLE 18.1 SEROQUEL XR 5.8 progesterone (oral) 13.5 sertraline hcl 5.5.1.3 PROGRAF 3 sildenafil 4.6.2 promethazine hcl 5.6 silver sulfadiazine 2.2 promethazine vc 15.2.1 SIMCOR 4.8.2.1 promethazine vc‐codeine 15.3 SIMPONI 3 promethazine‐codeine 15.3 simvastatin 4.8.2 promethazine‐dm 15.3 SINGULAIR 15.1.4 PROMETRIUM 13.5 SKELAXIN 11.3.2 propafenone hcl 4.7.1.3 sodium sulfacetamide/sulfur 6.3 propranolol hcl 4.4 SOFT TOUCH LANCETS 18.1 SOLARAZE 6.9.2 tilia fe 13.7 SOLODYN ER 45MG, 90MG, 135MG 2.1.7 timolol maleate 4.4 SOLODYN ER 55MG, 65MG, 80MG, 2.1.7 timolol maleate 14.5 105MG, 115MG TINDAMAX 2.7.5 sotalol 4.7.5 tizanidine hcl 11.3.1 SPIRIVA 15.1.3 TOBRADEX (ointment) 14.3 spironolactone 4.3.3 TOBRADEX ST 14.3 spironolactone/hctz 4.3.3 tobramycin sulfate 14.1.1 sprintec 13.7 tobramycin‐dexamethasone 14.3 SPRYCEL 3 tolterodine tartrate 16.1.1 STALEVO 5.7.2 TOPAMAX 5.4.7 stavudine 2.5.1 topiramate 5.4.7 STELARA 3 TOPROL XL 4.4 STRATTERA 5.9.6 torsemide 4.3.1 STRIANT 13.3 TOVIAZ 16.1.1 SUBOXONE SL FILM 5.1.1.2 TRACLEER 4.6.3 SUBOXONE SL TAB 5.1.1.2 TRADJENTA 8.1.5.2 sucralfate 9.4.1 tramadol hcl/er 5.1.1 sulfacetamide sodium 6.8 tramadol w/acetaminophen 5.1.1 sulfacetamide sodium 14.1.1 trandolapril 4.5.4.1 sulfamethoxazole/trimethoprim 2.1.6 TRANSDERM‐SCOP 5.6 sulfasalazine 9.6 TRAVATAN Z 14.5 sulindac 11.1.2 trazodone hcl 5.5.1.4 sumatriptan 5.1.2 tretinoin 6.3 sumatriptan injection 5.1.2 tretinoin 6.9.2 SUMATRIPTAN NASAL SPRAY 5.1.2 TREXIMET 5.1.2 SUPRAX 2.1.1 triamcinolone acetonide 6.1 SUPREP 9.6 triamcinolone acetonide nasal spray 7.2 SURESTEP TEST STRIPS 18.1 triamterene/hctz 4.3.3 SUTENT 3 triazolam 5.2.2 syeda 13.7 TRIBENZOR 4.5.6 SYMBICORT 15.1.3 TRICARE PRENATAL DHA ONE 13.1.1 SYMLIN/SYMLINPEN 8.1.4 TRICOR 4.8.1 SYNTHROID 8.4.1 trifluoperazine hcl 5.8 TACLONEX/SCALP 6.8 trifluridine 14.1.2 tacrolimus (oral) 3 trihexyphenidyl hcl 5.7.1 TAMIFLU 2.5.2 tri‐legest fe 13.7 tamoxifen citrate 3 TRILIPIX 4.8.1 tamsulosin hcl 16.1.4 trimethoprim 2.1.8 TARCEVA 3 trinessa 13.7 TAZORAC 6.8 tri‐previfem 13.7 TEKTURNA 4.5.6 tri‐sprintec tablet 13.7 TEKTURNA HCT 4.5.6 trivora‐28 13.7 temazepam 5.2.2 TRIZIVIR 2.5.1 terazosin hcl 4.5.1 trospium chloride 16.1.1 terbinafine hcl 2.3 TRUETEST TEST STRIPS 18.1 terbutaline sulfate 15.1.1 TRUETRACK TEST STRIPS 18.1 terconazole 2.4.1 TRUVADA 2.5.1 TESTIM 13.3 TWINJECT 15.1.3 testosterone cypionate injectable 13.3 TYVASO 4.6.2 tetracycline hcl 2.1.7 ULATRAVATE PAC OINTMENT 6.1 TEVETEN 4.5.4.2 ULESFIA 6.9.3 TEVETEN HCT 4.5.6 ULORIC 11.2 TEV‐TROPIN 10.2.4 ULTRAVATE PAC CREAM 6.1 theophylline anhydrous 15.1.2 unithroid 8.4.1 theophylline er 15.1.2 UROXATRAL 16.1.4 thioridazine hcl 5.8 ursodiol 9.6 thiothixene 5.8 VAGIFEM 13.4 thyroid 8.4.1 valacyclovir 2.5.2 ticlopidine hcl 12.4 valproic acid 5.4.4 valsartan‐hctz 4.5.6 XANAX/XR 5.2.1 VALTREX 2.5.2 XIFAXAN 2.8 VALTURNA 4.5.6 XOPENEX 15.1.1 vandazole 13.1.3 XOPENEX HFA 15.1.1 VECTICAL 6.8 XYREM 5.9.2 venlafaxine 5.5.1.4 zafirlukast 15.1.4 venlafaxine hcl er 5.5.1.4 zaleplon 5.2.2 VENTAVIS 4.6.2 zarah 13.7 VENTOLIN HFA 15.1.1 zatean‐pn plus 13.1.1 VERAMYST 7.2 ZEGERID PACKETS 9.4.2 verapamil hcl/er/er pm 4.2 ZEMPLAR CAPSULE 12.1.3 VEREGEN 6.9.2 zenchent 13.7 veripred 20 8.3.1 ZETIA 4.8.1 VESICARE 16.1.1 ZIAGEN SOLUTION 2.5.1 VEXOL 14.2 ZIAGEN TABLETS 2.5.1 VICTOZA 8.1.5.1 ZIANA 6.3 VICTRELIS 2.5.1 zidovudine 2.5.1 VIGAMOX 14.1.1 ziprasidone hcl 5.8 VIIBRYD 5.5.1.3 ZOLOFT 5.5.1.3 VIMPAT 5.4.7 zolpidem tartrate/er 5.2.2 VIRAMUNE XR 2.5.1 ZOMIG 5.1.2 VITAFOL‐ONE 13.1.1 ZOMIG NASAL SPRAY 5.1.2 vitamin d2 12.1.3 ZOMIG ZMT 5.1.2 VIVELLE‐DOT 13.4 zonisamide 5.4.7 VOLTAREN 6.9.5 ZOVIRAX 5% OINTMENT 2.6 voriconazole 2.3 ZUTRIPRO 15.3 VYTORIN 4.8.2.1 ZYCLARA 6.9.2 VYVANSE 5.9.1 ZYMAXID 14.1.1 warfarin sodium 12.3.1 ZYPREXA/ZYDIS 5.8 WELCHOL 4.8.1